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General NPI Number Information
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NPI Number | 1528079191
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Entity Type | Organization
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Legal Business Name | GERRITYS SUPERMARKET INC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 2280 SANS SOUCI PKWY HANOVER MALL
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City | HANOVER TOWNSHIP
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State | PA
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Zip | 18706-5049
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Country | US
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Telephone | 570-812-0016
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Fax | 570-812-0017
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Provider Business Mailing Address
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Address Line | 950 N SOUTH RD
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City | SCRANTON
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State | PA
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Zip | 18504-1430
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Country | US
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Telephone | 570-342-4144
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Fax |
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Authorized Official
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Title or Position | PHARMACY MGR
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Name | LISA DENTE
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Credential | PHARMD RPH
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Telephone | 570-812-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP481598
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License Number State | PA
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